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Calineata M, Jennewein L, Neef V, Flinspach AN, Louwen F, Zacharowski K, Raimann FJ. Safety and Efficiency of Low-Dose Spinal Analgesia Compared to Epidural Analgesia in Treatment of Pain during Labour: A Case Control Study. J Clin Med 2023; 12:5770. [PMID: 37762712 PMCID: PMC10532051 DOI: 10.3390/jcm12185770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/23/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The epidural catheter for analgesia has been used for decades and has become the gold standard in pain therapy for pregnant women in labour. However, procedural parameters such as time to pain relief and duration to implementation pose hurdles for patients shortly before delivery. Low-dose spinal analgesia (LDSA) is an alternative procedure that was investigated in the study with regard to patient satisfaction and complication rates compared to epidural catheter. METHODS In a retrospective monocentric study, a total of 242 patients receiving low-dose spinal analgesia or epidural catheters were evaluated using propensity score matching. Subjective patient satisfaction as well as complication rates were primarily analysed. We hypothesise that LDSA is a safe procedure and provides a similar level of satisfaction compared with the epidural catheter. For this purpose, both procedures were performed according to in-house standards and the patients were interviewed afterwards. Patients who required surgical delivery were excluded to prevent bias. RESULTS The LDSA was rated on average as very good [1.09 ± 0.311 vs. 1.07 ± 0.431] in terms of satisfaction by the patients compared to the epidural catheter without showing a significant difference (p = 0.653). Complications were in the low single-digit non-significant range for both procedures [6 (5%) vs. 7 (6%); p = 0.776]. The evaluation showed more perineal tears I° and II° in the low-dose spinal analgesia group [I°: 28 (23%) vs. 3 (2%); p < 0.001-II°: 30 (25%) vs. 2 (2%); p < 0.001]. Neonatal parameters differed significantly only in umbilical cord base excess and umbilical cord venous pH [-5.40 vs. -6.40; p = 0.005]. CONCLUSIONS LDSA represents a low complication procedure for patients at the end of labour with a high satisfaction level. With the LDSA in the repertoire of pain relief during childbirth, it is possible to also achieve pain reduction for women with deliveries of high velocity without compromising patient satisfaction or perinatal morbidity.
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Affiliation(s)
- Martin Calineata
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Lukas Jennewein
- Goethe University Frankfurt, University Hospital, Department of Gynaecology and Obstetrics, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Vanessa Neef
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Armin Niklas Flinspach
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Frank Louwen
- Goethe University Frankfurt, University Hospital, Department of Gynaecology and Obstetrics, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Kai Zacharowski
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Florian Jürgen Raimann
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Kähkönen K, Väänänen A. Labour analgesia by single shot spinal for any parturient?-A retrospective one-year single centre audit. Acta Anaesthesiol Scand 2023; 67:1079-1084. [PMID: 37217441 DOI: 10.1111/aas.14282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/27/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Single shot spinal (SSS) provides effective analgesia for multiparous parturients during advanced labour. Its utility in early labour or primiparous parturients may be limited by the insufficient duration of action. Regardless, SSS may offer a reasonable labour analgesia option in certain clinical scenarios. In this retrospective study, we analyse the failure rate of SSS analgesia by assessing pain after the SSS and by determining the need for additional analgesic interventions in primiparous or early-stage multiparous parturients compared to multiparous parturients in advanced labour (cervix ≥6 cm). METHODS Following institutional ethical board approval, the patient files of all parturients receiving SSS analgesia during a 12-month period in a single centre were analysed for any recorded notes regarding recurrent pain or subsequent analgesia interventions (a new SSS, epidural, pudendal or paracervical bloc) as a marker for insufficient analgesia. RESULTS A total of 88 primiparous and 447 multiparous parturients (cervix <6 cm: N = 131; cervix ≥6 cm: N = 316) received SSS analgesia. The odds ratio for the insufficient duration of analgesia was 1.94 (1.08-3.48) in primiparous and 2.08 (1.25-3.46) in early-stage multiparous parturients compared to advanced multiparous labour (p < .01). Primiparous and early-stage multiparous parturients were also 2.20 (1.15-4.20) and 2.61 (1.50-4.55) times more likely, respectively, to receive new peripheral and/or neuraxial analgesic interventions during delivery (p < .01). CONCLUSIONS SSS appears to provide adequate labour analgesia for the majority of parturients in whom it is used, including nulliparous and early-stage multiparous parturients. It remains a reasonable option in certain clinical scenarios, including resource-limited settings where epidural analgesia is unavailable.
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Affiliation(s)
- Kati Kähkönen
- Department of anaesthesiology, Central hospital of Seinäjoki, Seinäjoki, Finland
| | - Antti Väänänen
- Department of anaesthesiology, Helsinki University Central Hospital, Women's hospital, Helsinki, Finland
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Schyns-van den Berg AM, Gupta A. Postdural puncture headache - revisited. Best Pract Res Clin Anaesthesiol 2023. [DOI: 10.1016/j.bpa.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Aslan B, Moraloğlu Ö. Addition of Fentanyl or High-Dose Morphine to Bupivacaine Is Superior to Bupivacaine Alone during Single-Shot Spinal Anesthesia. Gynecol Obstet Invest 2020; 85:312-317. [PMID: 32781457 DOI: 10.1159/000509513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/25/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Single-shot spinal anesthesia (SSSA) with bupivacaine is a useful technique for pain control during the active phase of labor due to its simplicity and rapid onset. In this study, we evaluated the efficacy of the addition of fentanyl or high-dose morphine to bupivacaine during SSSA. METHODS Ninety healthy consecutive multiparous parturients in the active phase of progressing labor (cervical dilatation ≥7 cm; pain score >4) requesting analgesia were included in this study. The patients were randomly allocated into 3 SSSA groups as follows: group 1 (n = 30) receiving 2.5-mg hypobaric bupivacaine alone, group 2 (n = 30) receiving a combination of 2.5-mg hypobaric bupivacaine and 10-μg fentanyl, and group 3 (n = 30) receiving a combination of 2.5-mg hypobaric bupivacaine and 0.5-mg morphine. The duration of analgesia, VAS scores, side effects, and obstetric and neonatal outcomes were compared. RESULTS The main gestational age and cervical dilatation of the patients were 38.7 ± 1.5 months and 7.2 ± 2.2 cm (p = 0.14 and p = 0.65), respectively. The main VAS score significantly decreased in all groups at 3 h from baseline: from 8.25 to 1.75 in group 1, from 7.61 to 1.28 in group 2, and from 8.12 to 1.26 in group 3 (p < 0.001). The duration of the second phase of delivery was similar in all groups (45.5, 44, and 38 min, respectively; p = 0.67). The total analgesia duration was significantly higher in group 3 (172, 180, and 190 min for groups 1, 2, and 3, respectively; p = 0.01). The Apgar scores and fetal heart rates were similar in all groups (p = 0.95). Side effects were similar, except for pruritus in group 3 (p = 0.01). CONCLUSION The addition of fentanyl or high-dose morphine to bupivacaine increases the efficacy and duration of SSSA in the active phase of progressing labor without increasing side effects.
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Affiliation(s)
- Bilge Aslan
- Department of Anesthesia and Reanimation, Zekai Tahir Burak Training and Research Hospital, University of Health Sciences, Ankara, Turkey,
| | - Özlem Moraloğlu
- Department of Obstetrics, Zekai Tahir Burak Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Sharpe EE, Kim GY, Vinzant NJ, Arendt KW, Hanson AC, Martin DP, Sviggum HP. Need for additional anesthesia after single injection spinal analgesia for labor: a retrospective cohort study. Int J Obstet Anesth 2019; 40:45-51. [PMID: 31235213 DOI: 10.1016/j.ijoa.2019.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/24/2019] [Accepted: 05/27/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is little information about the use and efficacy of single injection spinal blocks for labor analgesia; specifically, how frequently subsequent analgesia or anesthesia is needed. This study determined how frequently an additional anesthetic intervention was needed in women who received single injection spinal analgesia. METHODS This retrospective study examined electronic medical records to find all single injection spinal analgesic blocks for labor analgesia over a 14-year (2003-2016) period. Patient and block characteristics and patient outcomes were recorded. The primary outcome was need for an additional anesthetic intervention following single injection spinal for labor analgesia. RESULTS Four-hundred-and-twenty-eight patients received single injection spinal blocks for labor and 60 (14.0%) needed an additional anesthetic either for labor analgesia (n=49) or an unexpected procedure (n=11). Two of these (0.5%) required general anesthesia. Parity of zero (nulliparous), a low cervical dilation at the time of the spinal injection, and induction of labor status, were associated with an increased risk of needing an additional anesthetic intervention. CONCLUSIONS This retrospective review provides evidence that single injection spinal anesthesia may be used for multiparous women with spontaneous labor and more advanced cervical dilation.
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Affiliation(s)
- E E Sharpe
- Departments of Anesthesiology, Mayo Clinic, Rochester, USA
| | - G Y Kim
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, USA
| | - N J Vinzant
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, USA
| | - K W Arendt
- Departments of Anesthesiology, Mayo Clinic, Rochester, USA
| | - A C Hanson
- Department of Biostatistics, Mayo Clinic, Rochester, USA
| | - D P Martin
- Departments of Anesthesiology, Mayo Clinic, Rochester, USA
| | - H P Sviggum
- Departments of Anesthesiology, Mayo Clinic, Rochester, USA.
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Teaching Neuraxial Anesthesia Techniques for Obstetric Care in a Ghanaian Referral Hospital. Anesth Analg 2015; 120:1317-22. [DOI: 10.1213/ane.0000000000000464] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Update on best available options in obstetrics anaesthesia: perinatal outcomes, side effects and maternal satisfaction. Fifteen years systematic literature review. Arch Gynecol Obstet 2014; 290:21-34. [PMID: 24659334 DOI: 10.1007/s00404-014-3212-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 03/04/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE In modern obstetrics, different pharmacological and non-pharmacological options allow to obtain pain relief during labour, one of the most important goals in women satisfaction about medical care. The aim of this review is to compare all the analgesia administration schemes in terms of effectiveness in pain relief, length of labour, mode of delivery, side effects and neonatal outcomes. METHODS A systematic literature search was conducted in electronic databases in the interval time between January 1999 and March 2013. Key search terms included: “labour analgesia”, “epidural anaesthesia during labour” (excluding anaesthesia for Caesarean section), “epidural analgesia and labour outcome” and “intra-thecal analgesia”. RESULTS 10,331 patients were analysed: 5,578 patients underwent Epidural-Analgesia, 259 patients spinal analgesia, 2,724 combined spinal epidural analgesia, 322 continuous epidural infusion (CEI), 168 intermittent epidural bolus, 684 patient-controlled infusion epidural analgesia and 152 intra-venous patient-controlled epidural analgesia. We also considered 341 women who underwent patient-controlled infusion epidural analgesia in association with CEI and 103 patients who underwent patient-controlled infusion epidural analgesia in association with automatic mandatory bolus. CONCLUSION No significant differences occurred among all the available administration schemes of neuraxial analgesia. In absence of obstetrical contraindication, neuraxial analgesia has to be considered as the gold standard in obtaining maternal pain relief during labour. The options available in the administration of analgesia should be known and evaluated together by both gynaecologists and anaesthesiologists to choose the best personalized scheme and obtain the best women satisfaction. Since it is difficult to identify comparable circumstances during labour, it is complicate to standardize drugs schemes and their combinations.
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Hein A, Rösblad P, Norman M, Ryniak S, Tingåker B, Jakobsson J, Dahlgren G. Addition of low-dose morphine to intrathecal bupivacaine/sufentanil labour analgesia: A randomised controlled study. Int J Obstet Anesth 2010; 19:384-9. [DOI: 10.1016/j.ijoa.2010.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Accepted: 04/02/2010] [Indexed: 10/19/2022]
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A comparison of paracervical block with single-shot spinal for labour analgesia in multiparous women: a randomised controlled trial. Int J Obstet Anesth 2009; 18:15-21. [DOI: 10.1016/j.ijoa.2008.01.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 01/01/2008] [Indexed: 11/22/2022]
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Kuczkowski KM, Chandra S. Maternal satisfaction with single-dose spinal analgesia for labor pain in Indonesia: a landmark study. J Anesth 2008; 22:55-8. [PMID: 18306015 DOI: 10.1007/s00540-007-0569-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 08/14/2007] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to assess maternal satisfaction with single-dose spinal analgesia for the management of obstetric pain in Indonesian women. The investigation included 62 laboring women with single pregnancy at term, with 45 primigravidas and 17 multigravidas. The participants' ages ranged from 15 to 29 years. All participants were screened for physical health and were classified as healthy according to the American Society of Anesthesiologists classification system. All 62 parturients received single-dose spinal anesthesia with a 27-gauge pencil-point needle at either the L3-4 or L4-5 intervertebral interspace, with a combination of bupivacaine, 2.5 mg; morphine, 0.25 mg; and clonidine, 45 microg. Maternal satisfaction, duration of pain relief, and side effects were studied. The overall maternal satisfaction with the single-dose spinal technique for labor analgesia in our study group was high, with 50 patients (81%) being very satisfied, and 7 patients (11%) being satisfied with the quality of labor analgesia. Forty-nine patients (79%) stated that they would select single-dose spinal analgesia for pain control in labor in the future. Our study was the first one in Indonesia to assess maternal satisfaction with single-dose spinal analgesia for labor pain. We concluded that single-dose spinal analgesia with a combination of bupivacaine, morphine, and clonidine provided effective labor pain control for Indonesian women, and maternal satisfaction with this technique was very high. This technique is very cost-effective and should be recommended for routine obstetric pain control in Indonesia and other developing countries.
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Arnaout L, Ghiglione S, Figueiredo S, Mignon A. Conséquences fœtales des techniques d’anesthésie au cours du travail. ACTA ACUST UNITED AC 2008; 37 Suppl 1:S46-55. [DOI: 10.1016/j.jgyn.2007.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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